Adult cancer patients on Home parenteral nutrition in Slovenia, data analysis in the Clinical Nutrition Unit in the Institute of Oncology in Ljubljana, in the period 2008–2012
Nada Rotovnik Kozjek, Barbara Koroušić Seljak
Zdravniški vestnik, 2014, 83: 232-239
Introduction: Home parenteral nutrition (HPN) represents a kind of therapy of intestinal failure. The system of HPN for adult patients was established in Slovenia by the Clinical Nutrition Unit in the Institute of Oncology, Ljubljana in 2008. The aim of the article is the analysis of Slovenian data on HPN in cancer patients in the four year period from 2008 to 2012. Patients and Methods: In the time period from 2008 to 2012, 53 cancer patients were included in the system of HPN in Slovenia - 19 males and 34 females. Results: The average age of the patients at enrollment into the HPN system was 53 years. This represents 74.6% of all patients on HPN who were registered in our unit in this period of 44 patients had advanced cancer, 9 patients had no recurrence of cancer during the observation period. In patients with advanced cancer tumors of the gastrointestinal tract (15 patients stomach and esophagus, 11 patients colon and rectum) and gynecological cancers (10 patients) were most frequently represented. Gastrointestinal obstruction (74%) was the major indication for long-term parenteral nutrition in cancer patients. 37 patients died during the observation period. Median survival time of these patients was 8 months (95% CI, 3.61 to 12.39 months). 27 patients received HPN during anti-cancer therapy (chemotherapy, radiotherapy, surgery. Medians for survival time of patients receiving an anticancer therapy and patients without any therapy were 11 months (95% CI, 3.72 to 18.28 months) and 2 months (95% CI, 1.26 to 2.74 months), respectively. The survival of patients with anticancer therapy was significantly longer (p <0.001). The majority of patients (90%) had HPN each day, 7 times per week. 28 patients (52%) had a complication of venous access. The most common cause of complication was infection in 15 patients (32%), which didn’t shorten the survival time of patients with advanced cancer (p < 0.001). Mean time to first catheter infection was 11 months. Conclusion: The results from a retrospective study represent the first Slovenian data on the survival time of cancer patients on HPN treatment due to intestinal failure. The results are comparable to results from European surveys which are a direct indicator that inclusion criteria for cancer patients used in Slovenia for HPN are good. Introduction of HPN as a therapeutic option also offer a possibility to continue with anticancer therapy and significantly improve the survival rate of patients with advanced cancer. They are also an indirect sign that the quality of HPN service is good and serves as a platform for the further development of HPN in cancer patients in Slovenia and at the same time for other patients who would need replacement therapy in the form of HPN due to intestinal failure.
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